| The percutaneous coronary intervention(PCI)is the most effective treatment for acute ST-elevation myocardial infarction(STEMI).The use of new anticoagulant bivalirudin has significantly reduced the risk of bleeding after PCI in patients with STEMI.However,it is not clear whether bivalirudin can prevent myocardial injury by inhibiting the inflammatory response in addition to its anticoagulant effect.We examined the changes of the plasma s ICAM-1 and CK-MB and c Tn T in the patients with STEMI before and after PCI to explore the anti-inflammatory and myocardial protective effects of bivalirudin.Methods: 79 patients with STEMI undergoing emergency percutaneous coronary intervention were selected in Huaihua Hospital Affiliated to University of South China from May 2015 to October 2016.The patients were randomly divided into bivalirudine anticoagulation group(n = 39 cases)and UFH anticoagulation group(n=40 cases).In the bivalirudine anticoagulation group,preoperative intervention was bivalirudine 0.75 mg per kilogram of body weight injection,and then according to 1.75 mg per kilogram of body weight per hour intravenous maintenance to the end of surgery(and at least maintainto 4 hours postoperatively).In the UFH anticoagulation group(n=40 cases),preoperative infusion of unfractionated heparin 100 U / kg bolus injection,according to the activation of thrombin time to adjust the amount of unfractionated heparin;intraoperative coronary artery thrombosis in patients with the situation by the doctor to decide whether to use the platelet IIIb / IIa receptor antagonist tirofiban.Forty healthy volunteers were selected as blank control group in our hospital health examination center.The levels of plasma s ICAM-1 in bivalirubin and heparin groups were measured before and 1hour and 24 hour after PCI.The level of plasma s ICAM-1 in the blank control group was compared with the level of s ICAM-1.In addition,plasma CK-MB and c Tn T levels also were detected before PCI in the two experimental groups.Results: 1.The levels of s ICAM-1 in Group Bivalirudin and Group Heparin were higher significantly than blank control Group(P<0.05).There was no statistical significance(P>0.05)in the levels of plasma s ICAM-1 before PCI between Bivalirudin and Heparin Groups.2.Bivalirudin group significantly decreased 24 hours after PCI the levels of s ICAM-1 and 1 hours after operation(P<0.05);heparin group 24 hours after operation the levels of s ICAM-1 and 1 hours after operation increased(P<0.05);and bivalirudin group 24 hours after operation was significantly lower than that of heparin group(s ICAM-1 there were significant differences in P<0.05);The level of plasma s ICAM-1 after 24 hours was significantly lower than that at 1 hour and pre-operation(P<0.05)in bivalirudin group.However,the level of plasma s ICAM-1 after 24 hours was significantly higher than that at 1 hour and pre-operationn in the Heparin group(P<0.05).The levels of plasma s ICAM-1 after 24 h in bivalirudin group was lower significantly than in the Heparin group(P<0.05)..3.The levels of plasma CK-MB and c Tn T after 24 hours were significantly lower than that at 1 hour and pre-operation in both groups(P<0.05).The levels of plama CK-MB and c Tn T after 24 h in bivalirudin group was decreased significantly than in the Heparin group(P<0.05).4.The events of clinical bleeding within 30 days after PCI did not showed significantly difference between the two groups(P>0.05);5.The incidence of major clinical events within 30 days did not showed significantly difference between the two groups(P>0.05);Conclusion: 1.Bivalirubin can reduce the level of s-ICAM1 and CK-MB and c Tn T in patients with STEMI after PCI,which suggest that bivalirubin could reduce the inflammatory response and myocardial injury after PCI.2.The anticoagulant effect of bivalirubine in patients with ACS was similar to that of heparin in patients with PCI.Bivalirubine has better security over heparin. |
PDF Full Text Request